Laserfiche WebLink
SAN JO' -lUIN COUNTY PUBLIC HEALTH $- ZVICES <br />Lf4VIRONMENTAL HEALTH DIVISIdfe <br />APPLICATION FOR UNDERGROUND STORAGE TANK CLOSURE PERMIT <br />THIS PERMIT FOR PERMANENTR'EMPORARY CLOSURE OR ABANDONMENT IN PLACE OF UNDERGROUND HAZARDOUS SUBSTANCES <br />STORAGE TANK(S) EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDICATE PERMIT TYPE: <br />n REMOVAL ❑ TEMPORARY CLOSURE ❑ CLOSURE IN PLACE <br />FACILITY INFORMATION <br />EPA SITE #CAL 000112867 PROJECT CONTACT Raymond Lopez PHONE# '209)462-0253 <br />FACILIT <br />` - <br />FACILITY NAME Air Port Way Lube Center PHONE # (209)462-0253 <br />ADDRESS 442 N. Air Port Way, Stockton, CA 95205 <br />CROSS STREET Fremont St. <br />OWNER OPERATOR Raymond Lopez PHONE*(20c))4C,2-02,53 <br />TANK INFORMATION <br />CONTRACTOR INFORMATION <br />CONTRACTOR NAME Jim <br />Thorpe Oil, Inc. I PHONE* (209)368-6175 <br />CONTRACTORADDRESS <br />P.O.OX 367 ICALIC# 495699 CLASSA B HAZ <br />INSURER emper/ <br />Genotar WORKERCOMP# 1095135 <br />FIREDISTRICT The City <br />of Stockton PERMIT# upon approval <br />LABORATORY NAME <br />UNTY PHONE # 572-0900 <br />SAMPLING FIRM <br />e0 nal tical La Ora Orl Q`10NE # J - 0 <br />TANK INFORMATION <br />TANK iC # <br />TANK SIZE TANK CONTENTS (PRESENTS PAST) DATE INSTALLED <br />39- D <br />1 00 val. Waste Oil unknown by contr <br />39- <br />39- <br />39- <br />39- <br />39- <br />APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS. FEDERAL LAWS, AND RULES AND <br />REGULATIONS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES. OWNER OR LICENSED AGENTS SIGNATURE CERTIFIES THE FOLLOWING: 'I <br />CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS <br />TO BECOME SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES <br />THE FOLLOWING: 'I CERTIFY THAT IN E FORMANCE OF THE K FOR WHICH THIS PERMIT IS ISSUED. I SHALL EMPLOY PERSONS SUBJECTTO <br />WORKER'S COMPENSATION LAWS 0 NIA.'�/ <br />APPLICANTS SIGNA <br />.ctor <br />❑ APPROVED 10 APPROVED WITH CONDITION(S) ❑ DISAPPROVED <br />(SEE CONDITIONS BELOW AND/OR ON ATTACHMENT) ��{- <br />PLAN REVIEWER'S NAME !/�Oi(Ai1.t_ DATED? L/ —4 <br />ANY DEVIATIONS FROM THTIS APPLICATION MUST BES BMITTED TO EHD FOR APPROVAL PRIOR TO COMMENCING WORK. <br />CONDITIONS: _ <br />I/4n S G¢` <br />_ s <br />EH 23 046 (REVISED 10/19/98) Page 3 <br />'L, <br />